Provider Demographics
NPI:1083982367
Name:ORTIZ - STOKES, ROSE M (LSW)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:ORTIZ - STOKES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-2519
Mailing Address - Country:US
Mailing Address - Phone:973-570-5331
Mailing Address - Fax:
Practice Address - Street 1:37 EVERGREEN PL
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2154
Practice Address - Country:US
Practice Address - Phone:973-570-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05732300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker